title: Beyond crisis resource management: new frontiers in human factors training for acute care medicine.
abstract: OBJECTIVE
  Error is ubiquitous in medicine, particularly during critical events and resuscitation. A significant proportion of adverse events can be attributed to inadequate team-based skills such as communication, leadership, situation awareness and resource utilization. Aviation-based crisis resource management (CRM) training using high-fidelity simulation has been proposed as a strategy to improve team behaviours. This review will address key considerations in CRM training and outline recommendations for the future of human factors education in healthcare.
  
  
  RESULTS
  A critical examination of the current literature yields several important considerations to guide the development and implementation of effective simulation-based CRM training. These include defining a priori domain-specific objectives, creating an immersive environment that encourages deliberate practice and transfer-appropriate processing, and the importance of effective team debriefing. Building on research from high-risk industry, we suggest that traditional CRM training may be augmented with new training techniques that promote the development of shared mental models for team and task processes, address the effect of acute stress on team performance, and integrate strategies to improve clinical reasoning and the detection of cognitive errors.
  
  
  CONCLUSIONS
  The evolution of CRM training involves a 'Triple Threat' approach that integrates mental model theory for team and task processes, training for stressful situations and metacognition and error theory towards a more comprehensive training paradigm, with roots in high-risk industry and cognitive psychology. Further research is required to evaluate the impact of this approach on patient-oriented outcomes.
authors.affiliation: aDivision of Emergency Medicine, Department of Medicine bDivision of Emergency Medicine, Department of Emergency Medicine, St. Michael's Hospital cDepartment of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Petrosoniak
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Hicks
mesh_terms: D002983:Clinical Competence; D003422:Critical Care; D003657:Decision Making; D004501:Education, Medical; D006801:Humans; D007318:Inservice Training; D010348:Patient Care Team; D016544:Patient Simulation; D012151:Resuscitation